Provider Demographics
NPI:1164638136
Name:HORNER, KIMBERLEY JANE (ND)
Entity Type:Individual
Prefix:
First Name:KIMBERLEY
Middle Name:JANE
Last Name:HORNER
Suffix:
Gender:F
Credentials:ND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10121 SE SUNNYSIDE RD
Mailing Address - Street 2:SUITE 300B
Mailing Address - City:CLACKAMAS
Mailing Address - State:OR
Mailing Address - Zip Code:97015-5745
Mailing Address - Country:US
Mailing Address - Phone:503-653-1816
Mailing Address - Fax:503-653-1817
Practice Address - Street 1:10121 SE SUNNYSIDE RD
Practice Address - Street 2:SUITE 300B
Practice Address - City:CLACKAMAS
Practice Address - State:OR
Practice Address - Zip Code:97015-5745
Practice Address - Country:US
Practice Address - Phone:503-653-1816
Practice Address - Fax:503-653-1817
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR0961175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath